title: Right-sided approach for management of left-main-bronchial stump problems.
abstract: OBJECTIVE
  Although the incidence of bronchopleural fistula (BPF) has decreased in the past decades, it remains a serious complication following pulmonary resection. The management of left-sided bronchial stump fistulas is difficult and depends on the choice of the approach. In contrast to several surgical procedures published in the past, herein we report our experience managing five left-main-bronchial stump (LMBS) problems through a right thoracotomy route.
  
  
  METHODS
  Five women, who underwent left pneumonectomy and later developed BPF, were managed with this novel procedure at our Institution. BPF appeared between 12 days and 24 years after pneumonectomy. Diagnosis of BPF or bronchoesophageal fistula (BEF) was made by computed tomography (CT) scan and fiberoptic bronchoscopy. Through a right posterolateral thoracotomy incision, the LMBS was re-stapled and covered with pedicled flaps in all cases. In patient #4, carinal resection was performed also, with temporary extracorporeal membrane oxygenation (ECMO) application.
  
  
  RESULTS
  The main results are depicted in the table. In all cases, encircling of the LMBS and stapling at the level of the carina was performed without difficulties. In patients #1, #2 and #3, resection of the bronchial stump remnant was also done and, in patient #4, carinal resection was also performed. All patients are doing well, with no evidence of recurrence of fistula.
  
  
  CONCLUSIONS
  We advocate the right posterolateral thoracotomy route for the management of left-sided BPFs as an alternative to transternal transpericardial and transthoracic closures. It is a safe, feasible and time-efficient approach that provides control of central structures and avoids previously manipulated or infected operative fields.
authors.affiliation: Thoracic Surgery and Lung Transplantation Unit, University Hospital Reina Sofía, Córdoba, Spain. pmoreno39@gmail.com
authors.forename: Paula
authors.initials: P
authors.lastname: Moreno
authors.forename: György
authors.initials: G
authors.lastname: Lang
authors.forename: Sharouk
authors.initials: S
authors.lastname: Taghavi
authors.forename: Clemens
authors.initials: C
authors.lastname: Aigner
authors.forename: Gabriel
authors.initials: G
authors.lastname: Marta
authors.forename: Angela
authors.initials: A
authors.lastname: De Palma
authors.forename: Walter
authors.initials: W
authors.lastname: Klepetko
mesh_terms: D000328:Adult; D001983:Bronchial Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010995:Pleural Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D011013:Pneumonectomy / Q000009:adverse effects; D016156:Respiratory Tract Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome